7 INTRODUCTION 7 UK Mobile health or just mhealth is the use of smartphones and tablets in health care, diagnosing and treatment. It is an industry that worldwide is growing rapidly year by year. In Denmark and Germany, it is an established and ever-growing industry with an annual turnover of several billion euros, which allows patients and clinicians to gain better and more relevant information for treatment, self-monitoring, access to hospitals, workflows and much more. Odense University Hospital, University Hospital Schleswig-Holstein Campus Kiel, Erhvervsakademiet Lillebælt, and Fachhochschule Kiel started this two-year project to develop a number of mhealth applications in selected clinical areas. The project aimed to identify existing national and international mhealth applications and explore the possibilities of establishing new, innovative services in a dialogue between patients and hospitals. the two schools and companies from the industry. The objective was that the two IT departments at the hospitals in Kiel and Odense would advance their skills in connection to updating, developing and servicing the apps developed by the industry. In this way, it is ensured that the developed apps will not become obsolete and useless but instead can be developed and adapted in collaboration with both users and the service organizations at the hospitals. Furthermore, safety, operational options, integration with existing systems and overall IT strategies would be taken into account. Ownership would also be with the IT departments in the hospitals. During the project phases, the target groups were invited to specific courses of development to ensure that the development was user-driven and tested. The clinicians were involved in the idea creation and discussion of the challenges. THE PROJECT The overall objective was to create specific new tools for clinicians and patients in the form of applications (apps) for smartphones in three areas: treatment, communication and diagnostics. The project focused on developing four to eight prototypes in close cooperation with users from hospitals, students from

12 12 PERSPECTIVE OUH By Maj Jørgensen UK Digital media, including mobile electronic health tools such as mobile phones and telemedicine technologies, are rapidly transforming the face of health service delivery in Denmark and Germany, as well as around the world. In short, mhealth will have a huge impact on how healthcare is delivered. It offers opportunities to address one of the most pressing global challenges: making healthcare more accessible, faster, better and less expensive. Mobile technologies are accelerating trends in healthcare. Three major trends already happening in healthcare lend themselves to the revolution in mobile technology: Ageing populations: Ageing populations and chronic illness are driving regulatory reform. Public sector health care is seeking better access and quality, and it is looking to the private sector for innovation and efficiency. Innovative mhealth initiatives improve access and quality while reducing cost. The platform: The foundations of the industrialisation of health care are already in place electronic patient journals, remote monitoring and communications. The idea of care anywhere is already emerging. The platform for mhealth is set. Personalisation: Health care, like other industries, is getting personal. mhealth can offer personal toolkits for predictive, participatory and preventive care. Expectations are high that mobile technology will help to transform our costly health care behemoths into less expensive, prevention-based and patient-focused systems; however, there is no quick fix! And this is also true concerning mhealth. New technology is not enough. The widespread adoption of mhealth will require changes in the behaviour of actors seeking to protect their interests. The challenge will be even greater for innovators because of the improvements that mhealth can bring (e.g., patient-centred care and a greater focus on prevention), and it will involve disruption of how health care is provided. To succeed, innovators must manoeuvre through culturally conservative, highly regulated and fragmented yet monopolistic systems that often provide contradictory incentives. That being said, future prospects of mhealth are promising. In Denmark, there is an increased political interest in mhealth, including its potential for promoting more patient-centred, preventive and cost-effective care.

16 16 PERSPECTIVE UKSH By Felix Prell UK We live in a time in which time itself has become a scarce commodity, especially doctors time. This is a trend that has been ongoing for a number of years, and there is no end in sight. The demographic changes in most of Europe are transforming our population pyramid into an urn form. For the medical profession, this means mainly two things: there will be more and more old people and there will be fewer and fewer doctors to treat them. This means that the average time one doctor can spend on one patient will decrease significantly. As this is an inevitable development, the task of paramount importance for medical doctors, clinics, hospitals and the entire health care system becomes finding an answer to the question of how to maintain adequate patient care with less time. Given the demographic developments we are facing, the answer to this question can be only technology. In the past, technological evolution in the field of medicine has often been a slow, tedious and very expensive endeavour. With the rise of mobile technology, however, this is changing drastically. Smartphones, tablets, wearables and all kinds of sensors have become a ubiquitous commodity. Development is happening at an amazing speed, and compared to regular medical technology, the gadgets are often surprisingly affordable. This new technology, if used sensibly, has the very real potential to solve the medical demographic crises we are facing. It is time to seize the opportunity to take health care to the next level.

20 20 PERSPECTIVE FH KIEL By Franziska Uhing UK Defining one s own challenge within the project scope of mhealth and collaborating institutes is an interesting task. To start off with the difficult part, a media-producing unit needs content and a specific target. But the idea of Interreg is not a ticket system; it is about exploring fields and defining new targets while cooperating with partners from a different subject area in this case, medicine, which certainly is a rich field for collecting, visualising and communicating patient data and medical knowledge. While performing research, one realises that there are telemedical projects sprouting up like mushrooms and becomes fascinated by the idea of participating in this innovation process. While finding out what features and services of a mobile device might be useful for medical purposes, one addresses possible partners who might be willing to join the quest. Innovative doctors like Prof. Dr. Jünemann, Prof. Dr. Jonat, and Dr. John were similarly convinced of the project s potential and willing to spend time exploring and researching mobile devices for mhealth. It takes time to get together on a working level, especially if the project is one that is reserved for the researchers spare time. This is where rapid prototyping with design mock-ups really helps to get a common idea of the possible product and its functions. In fact, usability is crucial. The next challenge is at the production level. With current mobile devices, the question of platforms and operating systems is a relevant one for a producer, and a web-based solution that targets multiple platforms was the answer in our case. The knowledge gained from this process was, again, fruitful for the department additional benefits of the project include the update of course contents in curriculum and the involvement of students in production processes, where possible. Overall, development on many levels and partners with inspiring ideas to share was very interesting indeed.

24 24 PERSPECTIVE EAL By James Norwood UK Simple question: when was the last time you checked your smartphone? The answer is probably a time somewhere in the last ten to twenty minutes. These devices have become our hubs for information and certainly an integral part of our social lives. Attaching health information and services to such devices makes sense From delivering advice on exercises to perform post-operation to offering support and communication to women after they have been diagnosed with cervical cancer, information-based solutions, which are timely and ready at hand, have the potential to change the way in which hospitals interact and communicate with patients. That is not to say that there are not other uses for this technology, as the VITA project has shown that the devices themselves can act as a bridge for communication with patients who are incapacitated after surgery. Motivation-based solutions mapped out by smart positional data and push mechanisms, as with the Fit Cook app, show that there are a host of solutions for improving health on many different social levels. Indeed, it is the ShareCare platform (developed by students from EAL) that utilised our basic need to communicate, enabling patients with illnesses to share their hopes and fears with others just like them in the safety of a hospital environment. We are moving into a future in which health information is not only delivered via hospitals but also generated by the patients themselves (quantified self). Wearable devices that are able to monitor all aspects of our physical and social well-being are becoming increasingly affordable and accessible. However, questions still remain as to how and who will be responsible for interpreting this data, but what is certain is that quantified self-movement has the potential to radically alter the way we interact and interface with our health care systems. As an academy, we continue to build upon the knowledge, skills and success of the Appliedhealth project, exploring new opportunities in the fields of self-monitoring and information-based health solutions of the future.

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